Sources of Folate Intake in Women at Risk for Cervical Cancer (CC) in an Era of Folic Acid Fortification

Abstract

A comprehensive evaluation of folate intake from different sources has not been documented among women at risk for CC in the US Post Folic Acid Fortification Era. The study objectives were to identify different sources of folate intake and document determinants of folate intake from these sources in 273 women of child bearing age tested positive for high‐risk human papillomaviruses (HR‐HPVs). Folate intake was assessed using the Block 98.2 semi‐quantitative food frequency questionnaire (FFQ). Daily folate equivalents (DFE) were calculated by multiplying synthetic folic acid (SFA) intake from fortified food and supplements with the correction factor of 1.7. The median intakes of natural folate (NF), SFA and total folate DFE were 175, 224 and 442 µg/d respectively. Higher DFE was associated with higher folate intake from SFA. Forty three percent of the women had folate intakes below the RDA (< 400 µg/d of DFE) and 8% of the women had intakes > 1000 µg/d of DFE, beyond the maximum safe amount. Women with lower education were less likely to have intakes > 175 µg/d of NF and > 224 µg/d of SFA (P=0.02 & P=0.04 respectively) while AA women and women in the highest tertile of HEI were more likely to have intakes > 175 µg/d of NF (P=0.003 & P=0.05 respectively). Current smokers were more likely to consume > 224 µg/d of SFA (P=0.003). Women with higher calories from alcohol were less likely to have an intake > 224 µg/d of SFA and > 400 µg/d of DFE (P=0.004 & P=0.02 respectively). These results demonstrated that race, level of education, HEI, smoking and alcohol consumption influences folate intake from different sources. Overall, however, below RDA consumption rather than exceeding intakes over 1000 µg/d is of concern in women at risk for developing CC. The study is supported by RO1 CA105448.